髓内扩张自锁钉与外固定架治疗胫骨开放性骨折的疗效评估

目的评估髓内扩张自锁钉(IESN)和外固定架治疗胫骨开放性骨折的疗效。方法自2003年10月—2005年9月采用髓内扩张自锁钉治疗胫骨开放性骨折41例,与38例采用外固定架治疗胫骨开放性骨折疗效进行对比分析。结果全部病例随访12~20个月,平均15.4个月,IESN组手术时间、术后平均发热时间和住院天数,骨折愈合时间分别为45min,2.3d,21d,9.5周,外固定架组分别为63min,3.2d,27d,13.2周。两组相比差异有统计学意义(t值分别为2.775,2.712,2.874,2.869,P均<0.01);IESN组无骨折延迟愈合及畸形愈合,无感染及内固定失败等并发症,而外固定架组出现9例感染,7例畸形愈合。结论髓内扩张自锁钉内固定在治疗胫骨开放性骨折中损伤小,并发症少,固定可靠,同时最大限度地保护骨断端血运,符合生物力学要求,在治疗胫骨开放性骨折中是一种有效的好方法。

Effects of IESN and External Fixation in Treatment of Open Tibial Fractures

Objective To evaluate the therapeutic effects of intramedullary expanding self-locking NaiI (IESN) and External Fixer on open tibial fractures.Methods From October, 2003 to September, 2005, 41 cases with open tibial fractures were treated with IBSN. A comparison was made between them and another 38 eases fixed by external fixation. Results All the patients were followed up from 12 to 20 months with an average of 15.4 months. The mean operative time was 45 min in the IESN group and 63 min in the external fixation group. The mean postoperative fever duration was 2.3 d in the IESN group and 3.2 d in the external fixation group. The mean hospitaIization was 2I d in the IESN group and 27 d in the external fixation group. The average clinical healing time of the fractures was 9.5 weeks in the IESN group and 13.2 weeks in the external fixation group (t=2.775, 2.712, 2.874, and 2.869; P<0.01). No delayed union or malunion, and no inflammation or internal fixation failure happened in the IESN group. However, nine cases of inflammation and seven cases of malunion occurred in the external fixation group. Conclusion IESN acts as an optional approach to treat open tibial fractures with firm fixation, higher healing rate and lower complication rate, and the blood supply of bone frame is well protected. According with the principle of biological fixation, it is an effective treatment to open tibial fracture.